Can routine automated urinalysis reduce culture requests?
Can routine automated urinalysis reduce culture requests?
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DOI：
10.1016/j.clinbiochem.2013.06.015
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发表时间：
2013-09-01
影响因子：
2.8
通讯作者：
Yucel, Dogan
中科院分区：
文献类型：
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作者：
Kayalp, Damla;Dogan, Kubra;Yucel, Dogan
目的：有大量不必要的尿培养要求。我们的目的是调查尿试纸和显微镜检查结果是否可以准确地排除尿路感染（UTI），而无需尿culture.Design和Methods：这项研究共包括32 998例（11 928名男性和21 070名女性，平均年龄：39 +/- 32岁）与初步诊断为UTI和尿分析和尿培养被要求。回顾性分析所有尿培养物;确定培养物阳性与化学分析中白细胞酯酶（LE）和亚硝酸盐阳性尿分析结果以及显微镜检查中脓尿（WBC）和菌尿的相关性。结果：共758例（2.3%）患者尿培养阳性。在这些培养阳性样品中，LE和亚硝酸盐的阳性试纸结果比率分别为71.0%（n = 538）和17.7%（n = 134）。WBC和细菌的阳性结果分别为68.2%（n = 517）和78.8%（n = 597）。LE、亚硝酸盐、菌尿和WBC的阴性预测值均接近100%。尿试纸和显微镜检查可以准确排除UTI。自动化尿液分析是一种实用和快速的筛查测试，可以避免大多数患者不必要的文化要求。(c)2013年加拿大临床化学家协会。爱思唯尔公司出版All rights reserved.
Objectives: There are a substantial number of unnecessary urine culture requests. We aimed to investigate whether urine dipstick and microscopy results could accurately rule out urinary tract infection (UTI) without urine culture.Design and methods: The study included a total of 32 998 patients (11 928 men and 21 070 women, mean age: 39 +/- 32 years) with a preliminary diagnosis of UTI and both urinalysis and urinary culture were requested. All urine cultures were retrospectively reviewed; association of culture positivity with a positive urinalysis result for leukocyte esterase (LE) and nitrite in chemical analysis and pyuria (WBC) and bacteriuria in microscopy was determined. Diagnostic performance of urinalysis parameters for detection of UTI was evaluated.Results: In total, 758 (2.3%) patients were positive by urine culture. Out of these culture positive samples, ratios of positive dipstick results for LE and nitrite were 71.0% (n = 538) and 17.7% (n = 134), respectively. The positive microscopy results for WBC and bacteria were 68.2% (n = 517) and 78.8% (n = 597), respectively. Negative predictive values for LE, nitrite, bacteriuria and WBC were very close to 100%.Conclusions: Most of the samples have no or insignificant bacterial growth. Urine dipstick and microscopy can accurately rule out UTI. Automated urinalysis is a practicable and faster screening test which may prevent unnecessary culture requests for majority of patients. (c) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.